Provider Demographics
NPI:1780984401
Name:GILMORE, JENNIFER THERESA (LPN)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:THERESA
Last Name:GILMORE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 GERO RD
Mailing Address - Street 2:
Mailing Address - City:MOOERS FORKS
Mailing Address - State:NY
Mailing Address - Zip Code:12959-2904
Mailing Address - Country:US
Mailing Address - Phone:518-236-7049
Mailing Address - Fax:
Practice Address - Street 1:35 GERO RD
Practice Address - Street 2:
Practice Address - City:MOOERS FORKS
Practice Address - State:NY
Practice Address - Zip Code:12959-2904
Practice Address - Country:US
Practice Address - Phone:518-236-7049
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-27
Last Update Date:2010-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY302808-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse